Blah Blah Blah…. “For India you are recommended to have your free NHS Hepatitis A and Typhoid”…. Cool that’s what my other friends have all decided to have as they’re free… Blah Blah Blah…. “Food and water precautions”…..I’m starving, wonder what to have for dinner tonight… Blah Blah Blah… “You are up to date with your tetanus, diphtheria and polio”… Great one less injection!… Blah Blah Blah… “Rabies is high risk”…. Blah Blah Blah… “£150 for the primary course of 3 immunisations”Blimey that’s expensive don’t think I’ll have those injections…  Blah Blah Blah… “In the event of a scratch or a bite, you would then only require 2 post exposure injections”…Blah Blah Blah… “In stead of 5 injections over 30 days and immunoglobulin”… Blah Blah Blah… “Malaria”…Oh looks like its brightened up outside, hopefully won’t get wet walking home…  Blah Blah Blah.

 

People do tend to ‘zone out’ during their travel clinic appointments especially when prices of vaccines are discussed or indeed have a lack of awareness of risks at their destinations.

Travel can be very expensive, flights, accommodation, activities, food, drink whilst away, equipment, clothes, travel insurance… etc…

Travel vaccinations tend to be low down on the list of priorities but are in fact very cost effective – the majority are effective for a few years, so if you are planning long haul trips in the future they are a good investment, and obviously they could also prevent you from becoming seriously unwell, disrupting your trip or having to spend a fortune on medical treatment whilst away.

Many travellers we see in our travel clinics are planning on visiting ‘high risk’ destinations for rabies.

 

Rabies is a serious, fatal infection transmitted through a scratch, bite or lick of broken skin/mucous membrane of an infected mammal- these include bats, dogs etc…

There is a pre travel/exposure vaccination course that consists of 3 injections on day 0, 7, 21 or 28. By completing this course you will be considered ‘fully immunised’ and as an infrequent traveller to a high risk destination will only then need to consider a booster at 10 years if you are travelling again to a high risk area, so it is good value for money. (This advice will alter for those travellers at continuous or frequent risk – the nurse will advise these travellers accordingly).

Guidance for considering immunising ‘infrequent travellers to high risk destinations’ includes:

  • Those travellers who may not be able to promptly (<24 hours) access a major medical centre for advice and safe, reliable post exposure rabies vaccine and immunoglobulin (if these products are available).
  • Those travelling for more than 1 month.
  • Those doing higher risk activities e.g. cyclists/runners
  • Those working or living in remote areas.
  • Children, who may lack awareness of the need to avoid animals or to report an animal bite.

 

You will always need post exposure treatment in the event of any suspected rabies contact, and what you receive post exposure will depend on what you have received pre exposure

.

Post Exposure Treatment:

 

High Risk Unimmunised/incompletely immunised Individual i.e. has not received 3 pre travel/exposure rabies injections Fully Immunised Individuali.e. has received 3 pre travel/exposure rabies injections
  Five doses (each 1ml ampoule of 2.5 IU) rabies vaccine on days 0, 3, 7, 14 and 30, plus HRIG (within 7 days of starting the course of vaccine) Two doses (each 1ml ampoule of 2.5 IU) rabies vaccine on days 0 and 3 – 7

 

 

Points to emphasise are that there is a worldwide lack of rabies post exposure immunoglobulin (HRIG), so you may have great difficulty accessing this at your destination, and even if post exposure rabies vaccines and immunoglobulin are available at your destination, they may not be safe or reliable. Immunoglobulin is a blood product and may also carry the risk for blood borne viruses e.g. HIV, Syphilis, Hepatitis B and Hepatitis C.

 

So if you are travelling to a high risk destination for rabies it is always worth considering a pre-exposure course of vaccine, as it is cost effective- booster not considered for another 10 yrs, and negates the need of ‘risky’/ ‘unavailable’ immunoglobulin at your destination if you have no immunity/pre travel injections.

Ultimately the advice is just to stay away from any animals!

 

Further reading/information on rabies and what to do immediately after any contact/emergency 1st aid:

http://www.who.int/rabies/rabnet/en.

http://www.nathnac.org/travel/factsheets/rabies1.htm.